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"It was over in a millisecond . . . " What Rame Nelson remembers most vividly about losing three fingers is how guickly it happened: "It was over in a millisecond ... I was ripping the piece and the next thing I knew my fingers were gone and one of them was lying there on the tablesaw. It's kind of funny, it wasn't all that painful ... juSt a hell of a shock at seeing my fingers gone." When I visited him in the hospital last February, juSt a week after his accident, Nelson had still not guelled his disbelief, and he was only beginning to understand how his accident had happened. Nelson was working late that night, pushing himself hard to finish a chest for display in the Michigan Woodworkers Guild show set to open rwo days later. While plunge-ripping a maple board on the tablesaw for the chest's base, Nelson missed his mark slightly. To line it up, he inched the board backward, with the rotation of the sawblade. "I was using my right hand to push it against the fence," he told me, "and I had my left hand on top of it. The thing caught the blade and pulled my hand right into it." The damage was extensive. The saw- blade raggedly severed at the knuckle the little and ring fingers on Nelson's left hand. He lost his middle finger nearly at its base. As such injuries go, Nelson was actually lucky. His father happened to be working with him at the time, and his shop in Walled Lake, Mich., is only 40 miles from Detroit's Harper-Grace Hospital, a leading center for the treatment of hand injuries. In his 13 years of woodworking, Nelson has considered the prospect of injury, even having gone so far as to post the names and numbers of hand surgeons by his telephone. "My first reaction was that I would bleed to death. In my panic, I didn't think to call anyone ... I JUSt wrapped my hand in a rag and we headed for the hospital." In their hasry departure, the rwo men collected Nelson's severed middle finger but missed his ring finger-which had landed on the jointer five feet away. His mangled little finger had been hurled into the recesses of the shop. Three hours later, Nelson was in sur- gery at Harper-Grace Hospital. His surgeon, Dr. Ronald Rusko, decided that only the middle finger could be saved. The other fWO fingers, retrieved later by Nelson's brother-in-law, were toO chewed up to work with. Peering through a microscope and using sutures small enough to pass through a human hair, Dr. Rusko painstakingly spliced the severed digital tendons, nerves and blood vessels in Nelson's hand. A steel pin was used to join the shattered bone. By the time I visited Nelson in the hospital, signs of healing were already evident. Although the reattached finger was still completely bandaged, he could feel sensation returning to it. And with the healing came the "phantom limb" effect, the eerie attempt by the nervous system to convince the brain that the missing extremities were still there. Dr. Rusko considers the operation a success, and when I talked to Nelson in June he reported steady but slow healing. "It's weird, though," Nelson said. "I can't believe how often I reach for something and come up short. " Reattachment microsurgery has been practiced only since the mid- 1970s, and though much progress has been made, it cannOt work miracles. "In general terms, no reattached limb is ever going to be normal. The worse the injury, the worse the outcome is going to be functionally," Dr. Rusko told me. Patients can expect stiffness, weakness and extreme sensitiviry to cold in salvaged fmgers. Sometimes, reattachment isn't worth the effort; surgeons freguently counsel against single-finger reattachment because the patient can often regain more use from a limber, well-formed stump than from a stiff replant. Nelson's middle finger was reattached because the doctor figured he stood a good chance of gaining rather than hindering function. Most reattachments reguire more surgery later, to remove scar tissue around tendons and nerves which can make the replant stiff and useless. Not surprisingly, injuries that are clean-cur offer the best prospects for success. by Paul Bertorelli With his practice located amidst hundreds of auto and manufacturing plants, Dr. Rusko sees his share of the bloodiest hand injuries, and Nelson's outcome is fairly rypical. Others, however, can't count on being as fortunate. Time is important in reattachment, and since not every hospital is eguipped to do this rype of microsurgery, the closest help may be hours away. Depending on the circumstances, severed fingers can be replanted up to 12 hours or more after the injury, but the longer the wait, the fewer the surgeon's choices. Dr. Rusko says the injured person can help himself most by keeping his wits after the injury. You aren't likely to bleed to death even after losing several fingers. Sterile dressings kept in the shop can be used to wrap the injured hand for the trip to the hospital. Apply direct pressure to the wound (tourniguets are rarely necessary) and elevate the hand higher than the heart. As gruesome as it may be, you've gOt to pick up the lost fingers and carry them with you to the hospital in a container or a clean towel. Don't bother with any tOpical treatments like iodine or ointments. Nelson's list of hand surgeons near the phone is a good idea, but it's even better to know the location of the closest hospital eguipped to do microsurgery. Even the best surgeon and a guick trip to the hospital after the injury, however, fall far short of avoiding the accident in the first place. This point is not lost on Rame Nelson. ''I'm embarrassed that I could do something so stupid. I've always had a second nature about safery and I'm still surprised this could happen to me. " Sitting in Nelson's hospital room, I couldn't help thinking about all the times I've worked late or done crazy things with machines while trying to finish a job in a hurry. I've taken false comfort in my lack of injury, but now I wonder if my intact hands are due more to dumb luck than ro skill and good sense. The point isn't lost on me either. Next time I feel brain-fade from exhaustion, I'll turn out the shop lights and try again the next day. 0 87